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General NPI Number Information
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NPI Number | 1710323738
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE MEDICAL REHABILITATION P.C.
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 355 POST AVE STE 104
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City | WESTBURY
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State | NY
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Zip | 11590-2265
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Country | US
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Telephone | 516-333-3253
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Fax | 516-333-8452
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Provider Business Mailing Address
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Address Line | 355 POST AVE STE 104
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City | WESTBURY
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State | NY
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Zip | 11590-2265
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Country | US
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Telephone | 516-333-3253
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Fax | 516-333-8452
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | KWAN-IONG L JAKOBSEN
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Credential |
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Telephone | 516-333-3253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 197595
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License Number State | NY
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